Tag Archives for personalized medicine
Self-Tracking for Behavior Change
I just invested in a Nike+ Sport kit, which, though they have been around for a while, just peaked my curiousity thanks to my reading of The Decision Tree. The author of that book, Thomas Goetz, points out that one of the most effective ways of motivating people to change their behaviour is to get them tracking their habits. For Weight Watchers, it’s points. For Nike+, it’s the distance and pace of your running.
All the Nike+ system is is a little doo-hickey that plugs into your iPod nano, and another little one that you stick in your shoe. I wasn’t too excited about switching shoe brands, so I hacked my Mizuno shoes that I know and love. But you can read about that elsewhere.
Once calibrated, the system is pretty slick. You can select a workout based on time (eg. 30 minutes), distance (5k, 3 miles), calories or free form. Then you pick some tunage to listen to while you run, and off you go. I have mine tracking in kilometers, and a kind voice pops up every once in a while to say “.5 k completed” or “300 meters left.”
When you’re done, you go home and sync your iPod and it zaps you out to nikeplus.com where your data is waiting for you to review. You can log a couple things yourself like how you felt, what the weather was like and the surface on which you were running. A graph of your pace shows how inconsistently fast or slow you were gadding about.
Other cool features:
- Goals: Set personal goals for distance, pace, etc.
- Nike+ Coach: training programs for you to follow to prepare for a race distance. This is hands-down my favorite feature of Nike+ so far. I have wanted to train for a half-marathon and went looking for a program but came back disappointed in the price and questionable quality of the programs online.
- Challenges: Other users of Nike+ create public goals and challenges for you to join and run along with them. Probably not for me, but a nice way to “socialize” the system.
I hope that Goetz is right and Nike+ gets me out a little more often. He argues that systems like these are often effective for getting people to change to healthy behaviors (link  to the AJPM study mentioned in that post) because they serve as personal motivators. Being able to systematically record your runs and easily watch your progress over the lifespan of your exercise program is certainly motivating for me.
23 and Me, Navigenics and personal genomics: Empowering or Frightening? Continue Reading →
The Decision Tree by Thomas Goetz is an excellent call-to-arms for personalized medicine and taking control of the options that you, as a patient, now have in our new era of healthcare. Goetz has an extraordinary ability (honed at Wired Magazine) to parse complicated scientific topics into clear and efficient prose.
He touches on many personal stories, some that have been heard before in medical non-fiction (like an Ashkenazi Jew being tested for BRCA1, the genetic mutation that often leads to breast cancer. An almost identical story is related, somewhat ironically, in one of Dr. Jerome Groopman’s early books, but more on him in a minute). Other stories are newer, and focus on some other possibilities of not only genetic testing but also of self-tracking and patient communities, and this is where the book really shines.
Goetz illuminates many of the technologies that are allowing modern patients track and control their health, such as Nike+, 23 and Me, PatientsLikeMe and many others. He also sheds new light on Weight Watchers and explains, by way of what we know now from other self-tracking programs (and other failed diet regimes), why the Weight Watchers model of “points” and group meetings has been so successful for so many.
The one thing that doesn’t quite stack up is the title of the book itself. It is my hunch that using the “decision tree” metaphor to explain the unique choices that we will all have to face as patients is an attempt to legitimize patient activism by translating it into a scientific and statistical model often used in evidence-based medicine (for an example of using decision trees in evidence-based clinical care, see here).
Integrating patient activism into the paradigms of modern medicine is difficult and requires the eloquence and dedication that Goetz provides in this book. Too often patients still meet the locked doors of the ivory tower. But Goetz does a good enough job explaining the different choices each of his examples faces, that the “decision trees” themselves do not add much to the book; if anything, they consistently struck me as over-simplified pictures of a situation just described in detail. It is vital to know and to learn the ins and the outs of your medical situation in order to assist your doctor in your treatment plan. But whether you jot notes in a book or mock-up your choices in SketchUp seems inconsequential.
It is also important that patients not forget the lynchpins of their care in the face of all these wonderful (but often distracting and sometimes frightening) technological tools: their doctors. I recently came across an excellent encapsulation of this book by @Doctor_V as compared to Dr. Jerome Groopman’s “How Doctors Think.” In it, he sets up the two books as opposite one another; the latter arguing for a golden-age of wisdom handed down by Harvard-trained “Masters of the Universe,” while the former seems to push self-tracking and patient activism so hard that there is hardly for a doctor in your care whatsoever. As a librarian, I’ll now be hard pressed to recommend either one without the other.